Abstract
Objective: This study evaluates the preoperative and postoperative systemic immune-inflammation index (SII) capacity to predict the prognosis of patients with endometrial carcinoma after the operation and build a nomogram model to assist clinical practice.Methods: The retrospective study included 362 consecutive patients with surgically resected endometrial cancer between January 2010 and June 2015 at The Affiliated Cancer Hospital of Shantou University Medical College. Blood routine was examined within 1 week before surgery to calculate SII, NLR, PLR, and MLR and 3 days after surgery to measure SII. The Pearson's χ2-test or Fisher's exact test was used to explore their relationship to clinical variables. The univariate and multivariate survival analyses were performed by Cox regression to identify the independent prognostic indicators. The Kaplan–Meier method with the log-rank test was used to generate the overall survival (OS) curves. R software was used to generate the receiver operating characteristic (ROC) curve and then it got the optimum cutoff value through the maximum Youden index. A nomogram model was formed with systemic immune inflammation and clinical factors.Results: The preoperative SII was related to age (p = 0.009), FIGO stage (p = 0.02) and menopause (p = 0.014). The postoperative SII was associated with menopause (p = 0.014). Univariate analysis indicated that FIGO stage, lymphatic invasion, depth of myometrial invasion, postoperative chemotherapy, postoperative radiotherapy, preoperative SII, NLR, PLR, MLR, CRP, CA125, and postoperative SII were predictors of OS (p < 0.05). Multivariate analysis showed that lymphatic invasion and postoperative SII were independent prognostic factors of OS (p < 0.05). The nomogram model was visualized precisely to reflect the prognosis with a C-index value of 0.866 in this model.Conclusion: The postoperative SII is the independent prognostic factor in patients with endometrial carcinoma after the operation and contributes to poor outcomes. However, after surgery, the preoperative SII and preoperative NLR, PLR, and MLR are not associated with OS endometrial carcinoma. Making good use of the nomogram model would contribute to better subsequent therapy.
Highlights
The continued increase in incidence for endometrial cancer (1.3% per year from 2007 to 2016) and endometrial cancer survival has not improve due to delayed marriage and childbearing and the rising rate of obesity [1]
Our research aims to evaluate the predicted prognosis of preoperative and postoperative systemic immune inflammation (SII) in patients with endometrial cancer
There were 229 (93.1%) patients that were diagnosed with type I cancer and 17(6.9%) patients diagnosed with type II cancer
Summary
The continued increase in incidence for endometrial cancer (1.3% per year from 2007 to 2016) and endometrial cancer survival has not improve due to delayed marriage and childbearing and the rising rate of obesity [1]. Endometrial cancer subtypes are classified into type I and II cancers. Type I cancers are estrogen-dependent, connected with abnormal uterine bleeding, diabetes, obesity, hyperestrogenism, hypertension, delay of menopause, and functional ovarian cancer. The typing of dualism exists in conformity between part case and pathological features [2]. The Cancer Genome Atlas (TCGA) [3] based on molecular characteristics classified into four subtypes, including POLE-mutation (POLE mt), microsatellite instability (MSI), low-copy-number, and highcopy-number [4, 5]. These novelty subtypes are not yet widely used in clinical practice because of the high cost and technical problems
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